The Future of Marginal Kidney Repair in the Context of Normothermic Machine Perfusion

Overview

Journal Am J Transplant

Publisher Elsevier

Specialty General Surgery

Date 2018 Jun 8

PMID 29878499

Citations 31

Authors

Jenna R DiRito

Sarah A Hosgood

Gregory T Tietjen

Michael L Nicholson

Affiliations

Soon will be listed here.

Abstract

Normothermic machine perfusion (NMP) is a technique that utilizes extracorporeal membrane oxygenation to recondition and repair kidneys at near body temperature prior to transplantation. The application of this new technology has been fueled by a significant increase in the use of the kidneys that were donated after cardiac death, which are more susceptible to ischemic injury. Preliminary results indicate that NMP itself may be able to repair marginal organs prior to transplantation. In addition, NMP serves as a platform for delivery of therapeutics. The isolated setting of NMP obviates problems of targeting a particular therapy to an intended organ and has the potential to reduce the harmful effects of systemic drug delivery. There are a number of emerging therapies that have shown promise in this platform. Nutrients, therapeutic gases, mesenchymal stromal cells, gene therapies, and nanoparticles, a newly explored modality, have been successfully delivered during NMP. These technologies may be effective at blocking multiple mechanisms of ischemia- reperfusion injury (IRI) and improving renal transplant outcomes. This review addresses the mechanisms of renal IRI, examines the potential for NMP as a platform for pretransplant allograft modulation, and discusses the introduction of various therapies in this setting.

Citing Articles

A Guide to the Implementation and Design of Ex Vivo Perfusion Machines for Vascularized Composite Allotransplantation.

Muss T, Loftin A, Zamore Z, Drivas E, Guo Y, Zhang Y Plast Reconstr Surg Glob Open. 2024; 12(11):e6271.

PMID: 39534373 PMC: 11557116. DOI: 10.1097/GOX.0000000000006271.

CC-4066 therapy delivered to kidneys during cold storage and assessed with normothermic reperfusion is feasible and safe.

Meertens P, Mellati A, Dumbill R, Lo Faro M, Rozenberg K, Mulvey J Front Transplant. 2024; 2:1166661.

PMID: 39055309 PMC: 11270626. DOI: 10.3389/frtra.2023.1166661.

Mesenchymal Stem Cells and Extracellular Vesicles: Therapeutic Potential in Organ Transplantation.

Pan W, Li S, Li K, Zhou P Stem Cells Int. 2024; 2024:2043550.

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Potassium canrenoate in brain-dead organ donors: a randomised controlled clinical trial protocol (CANREO-PMO).

Belarif L, Girerd S, Jaisser F, Lepage X, Merckle L, Duarte K BMJ Open. 2023; 13(10):e073831.

PMID: 37821131 PMC: 10582869. DOI: 10.1136/bmjopen-2023-073831.

Expanding the Horizons of Pre-Transplant Renal Vascular Assessment Using Ex Vivo Perfusion.

Campos Pamplona C, Moers C, Leuvenink H, van Leeuwen L Curr Issues Mol Biol. 2023; 45(7):5437-5459.

PMID: 37504261 PMC: 10378498. DOI: 10.3390/cimb45070345.

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